OSTEOPOROSIS

To see a larger version click here

Disorder where certain bones (notably vertebrae, hip bones, wrist bones) become fragile and at risk of fracture. Bone is an active tissue in a constant state of turnover. Bone density peaks at c. 30 years, and peak bone mass is boosted by weight-bearing exercise and adequate calcium intake. In some individuals, the subsequent decline in bone density escalates to osteoporosis.

Prevention and detection of osteoporosis, and management of existing disease, are important because of its potentially disabling consequences, for example, spinal collapse as a result of vertebral fractures, loss of mobility following a hip fracture.

Risk factors

Factors associated with a high risk of osteoporosis include:

• Frailty
• Untreated hypogonadism
• Premature menopause
• Long-tem corticosteroid use
• Diseases associated with malabsorption, e.g. Crohn’s disease, coeliac disease
• Radiological osteopenia (reduced bone density).

Other risk factors include:

• Family history, low body weight, history of eating disorder, smoking history, high alcohol consumption, previous fragility fractures, i.e. fractures occurring after a fall from standing height, commonly of the wrist or hip.

Screening and treatment

Recommendations on eligibility for osteoporosis screening and treatment are complicated. Screening for osteoporosis is by dual-energy x-ray absorptiometry (DEXA) scanning (see table below), and drug treatment can boost bone strength.

Risk estimation

The WHO developed the FRAX tool for evaluation of a patient’s fracture risk. Algorithms give a 10-year probability (absolute risk) of hip fracture and of a major osteoporotic fracture (spine, forearm, hip or shoulder). UK researchers have developed QFractureScores, alternative fracture risk algorithms for use in the UK.